Healthcare Provider Details

I. General information

NPI: 1588779466
Provider Name (Legal Business Name): DUC HUU NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 AVOCADO AVENUE, SUITE 106 126 AVOCADO AVE, SUITE 106
PERRIS CA
92571
US

IV. Provider business mailing address

126 AVOCADO AVENUE, SUITE 106 126 AVOCADO AVE, SUITE 106
PERRIS CA
92571-4200
US

V. Phone/Fax

Practice location:
  • Phone: 951-943-7212
  • Fax: 951-943-0139
Mailing address:
  • Phone: 951-943-7212
  • Fax: 951-943-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number20A9168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: